Non-technical skills learning in healthcare through simulation education: Integrating the SECTORS learning model and Complexity theory

Background: Recent works have reported the SECTORS model for non-technical skills learning in healthcare. The TINSELS programme applied this model, together with complexity theory, to guide the design and piloting of a non-technical skills based simulation training programme in the context of medicines safety. Methods: The SECTORS model defined learning outcomes. Complexity Theory led to a simulation intervention that employed authentic multi-professional learner teams, included planned and unplanned disturbances from the norm and used a staged debrief to encourage peer observation and learning. Assessment videos of non-technical skills in each learning outcome were produced and viewed as part of a Non-Technical Skills Observation Test (NOTSOT) both pre and post intervention. Learner observations were assessed by two researchers and statistical difference investigated using a student’s t-test Results: The resultant intervention is described and available from the authors. 18 participants were recruited from a range of inter-professional groups and were split into two cohorts. There was a statistically significant improvement (P=0.0314) between the Mean (SD) scores for the NOTSOT pre course 13.9 (2.32) and post course 16.42 (3.45). Conclusions: An original, theoretically underpinned, multi-professional, simulation based training programme has been produced by the integration of the SECTORS model for non-technical skills learning the complexity theory. This pilot work suggests the resultant intervention can enhance nontechnical skills

Teacher talk during CPD: An exploration of talk as a tool for reflective inquiry into practice

This qualitative case study examines the role of specialist reading teachers’ talk during CPD and how their talk develops as dialogue which enables them to inquire reflectively into practice. Despite a large body of research into teacher learning through CPD, how teachers talk within CPD has had less attention from the field compared to the interest in CPD designs and factors which contribute to CPD effectiveness. In addition, most interest from the field into the role of talk in learning, has concentrated on classroom talk and the exchanges between teachers and children. Consequently, the findings from this study add to current understanding of how individuals learn from CPD and the role played in their learning by their participation in dialogue about practice observation. The study was situated in the CPD context of an established group of Reading Recovery teachers. Data were generated from observation and audio-transcripts of the CPD event and through group and individual interviews with the teachers and the group leader. A grounded theory approach to data analysis was used to explore the nature of dialogue in this context and participants’ explanations of their roles and learning. The premise of this thesis is that teachers’ adaptive expertise is extended through reflective inquiry when their collaborative talk is used to assemble and interrogate data from observed lessons, theorise about decision-making and propose and test hypotheses about what they observe. Although there was individual variation, and factors other than length of experience were significant in teachers’ participation in reflective inquiry, the analysis indicates that by collaboratively problematising practice, teachers can develop deeper rationales for their decision-making and are able to synthesise theoretical and practical knowledge. I propose that developing and maintaining an inquiry stance through dialogue generates reflective inquiring leading to learning transformation

OntoCAT - an integrated programming toolkit for common ontology application tasks

OntoCAT provides high level abstraction for interacting with ontology resources including local ontology files in standard OWL and OBO formats (via OWL API) and public ontology repositories: EBI Ontology Lookup Service (OLS) and NCBO BioPortal. Each resource is wrapped behind easy to learn Java, Bioconductor/R and REST web service commands enabling reuse and integration of ontology software efforts despite variation in technologies

The Effect of Dietary Sulfur on: I. Glutathione S-Transferase Activity in Rat Lung and Liver; and II. The Hepatic Metabolism and Urinary Excretion of Acetaminophen in Adult Male Rats

In Part I, the effect of dietary sulfur on glutathione S-transferase (GDH S-T) activity was evaluated in male Sprague-Dawley rats. The animals were fed diets containing inorganic sulfate (SO4=) at the levels of 0.0072%, 0.027%, or 0.427%. At each level of SO4=, there was either no organic sulfur supplementation or supplementation with cysteine or methionine. There was no effect of dietary SO4= GSH S-T activity in lung and liver supernatants when the group means were analyzed by the method of planned comparisons. There were significant interaction effects between treatments. Supplementation of diets with organic sulfur reduced GSH S-T activity in both tissues. GSH S-T activity was greater in lung supernatants when rats were fed diets containing cysteine versus methionine. The opposite effect was observed in liver supernatants. In Part II, the effect of dietary sulfur on the hepatic metabolism and urinary excretion of acetaminophen (APAP) in rats was examined. Male Sprague-Dawley rats were fed diets identical to those used in Part I. Twenty-four hours prior to sacrifice, rats received an injection (i.p.) of APAP (300 mg/kg) in saline. Control animals received an injection of saline alone. In the liver administration of APAP increased tissue glutathione (GSH) concentration but did not affect the activities of GSH S-T, sulfotransferase (ST), and UDP-glucuronyl transferase (UDP-GT). Dietary SO4= had no effect on hepatic enzyme activities or GSH concentration. Hepatic GSH S-T activity was decreased and GSH concentration was increased in rats fed diets supplemented with organic sulfur. In the urine, the excretion of APAP sulfate was unaffected by either the level of dietary SO4= or the presence or type of organic sulfur supplementation. The excretion of APAP mercapturic acid was greatest at the lowest (0.0072%) level of dietary SO4= and tended to decrease as the level of dietary SO4= increased. Supplementation of diets with organic sulfur reduced the excretion of APAP glucuronide and APAP mercapturic acid. Only the excretion of APAP glucuronide was affected by the type of organic sulfur supplementation. This study provides evidence that xenobiotic metabolism in rates is affected by dietary sulfur

A Study of Life Crisis Magnitude of Psychiatric Patients and a Non-Therapy Group

A group of hospitalized psychiatric patients and a randomly selected non-therapy group responded to the Schedule of Recent Experiences questionniare. In order to determine the magnitude of life change events for the two groups, Life Change Unit totals were derived for the years 1966 and 1967. To test the hypothesis that patients in psychiatric treatment have experienced a quantitatively significant greater amount of life change than a group of non-therapy subjects, an analysis of variance was used to determine whether there were significant differences between the scores for the two groups. For the year 1966, no significant difference was found between the therapy and non-therapy samples. For the year 1967, there was a significant difference between the mean Life Change Unit scores for the two groups. As a result of these findings, it is concluded that an accumulation of life change events may serve to precipitate mental health change, and that that probability of such health change occurring is significantly greater when there is a clustering of life change events during any given year than when such a clustering does not occur

The Influences of Caregiver-Child Interactions and Temperament on Cortisol Concentrations of Toddlers in Full-Day Childcare

The purpose of this study was to explore the influences of caregiver-child interaction and temperament on cortisol concentrations of toddlers in full-day childcare. Sensitive and responsive caregiving is critical to the quality of children\u27s early experiences. Caregivers who are attuned to unique needs of young children can support and guide child growth and development. In the context of relationships the child grows, develops, and learns to biologically respond to events in his or her world that he or she may perceive as threatening, with the production of cortisol. Studies show that regulation of cortisol release later in life may be shaped by social experiences during early development. This exploratory study investigated the influences of caregiver-child interaction and temperament as measured by the Early Childhood Behavior Questionnaire (ECBQ) on cortisol concentrations in toddlers in full-day childcare. Seventy-three (31female, 42 male) toddlers, in 11 full-day childcare classrooms in communities in southern Appalachia participated. Classrooms were evaluated using the toddler Classroom Assessment Scoring System (CLASS) and an adapted version of the Engagement Check II. Morning and afternoon cortisol concentration was measured in enzymeimmunoassays of saliva. Findings indicated that as years of teacher experience increased, cortisol concentrations decreased. Likewise, as the percentage of time toddlers were engaged in developmentally appropriate activities increased, cortisol concentration decreased. Mean cortisol concentrations decreased from mid-morning to mid-afternoon. Findings of individual cortisol concentrations were mixed. Temperament data showed a relationship between management of arousal or impulse control (surgency) and cortisol concentration. No statistically significant correlation was found between cortisol concentration and the dimensions of the toddler CLASS. Regression analysis of the 3 dimensions of temperament (negative affect, effortful control, surgency) showed surgency to be related to cortisol concentration. The study adds to the body of research on very young children in full-day childcare and elevated cortisol concentrations by including children in communities in southern Appalachia as well as measuring teacher-child interaction in childcare using the newly released toddler CLASS. Future research is needed to delineate the developmental outcomes and long-term impact of excess stress in this population

Concurrent partnerships and HIV: an inconvenient truth

The strength of the evidence linking concurrency to HIV epidemic severity in southern and eastern Africa led the Joint United Nations Programme on HIV/AIDS and the Southern African Development Community in 2006 to conclude that high rates of concurrent sexual partnerships, combined with low rates of male circumcision and infrequent condom use, are major drivers of the AIDS epidemic in southern Africa. In a recent article in the Journal of the International AIDS Society, Larry Sawers and Eileen Stillwaggon attempt to challenge the evidence for the importance of concurrency and call for an end to research on the topic. However, their "systematic review of the evidence" is not an accurate summary of the research on concurrent partnerships and HIV, and it contains factual errors concerning the measurement and mathematical modelling of concurrency

A Look at Public Health

PDF pages:

Prospective ongoing prescribing error feedback to enhance safety: a randomised controlled trial

Background Prescribing errors are one of the most common adverse events in healthcare. Previous research in patient safety has highlighted the importance of error awareness education to enhance professional attitudes and reduce errors. Previously researched systems of contemporaneous prescribing feedback are limited by shift working. A pilot study investigating a ward-specific system of prospective ongoing prescribing error feedback to prescribers led to a significant reduction in errors. This study investigated the introduction of the system over several wards to reduce errors. Methods A ward cluster randomised controlled trial was conducted in a UK teaching hospital, including all medical prescribers in four randomised inpatient ward areas. After an assessment of prescribing on each ward, a ward-specific feedback document was prepared, giving general and anonymous feedback, and forwarded to all consented participants in the intervention areas. The primary outcome was total prescribing order error rates; secondary outcome measures included clinical order error rates, technical order error rates and cost per error prevented. Results A total of 1493 medication orders were assessed for errors. There was no difference in error rates at baseline (32.4 vs 42.6%, p = 0.594). After the introduction of the prospective ongoing prescribing error feedback, there was significant difference in the overall rates of error (64.8 vs 26.3%, p = 0.003). Similarly, there were statistically significant differences in the rates of clinical error (p = 0.003) and technical error (p = 0.013) on completion. The modelled cost of errors prevented in the intervention wards was £2.56 per error. Conclusions A simple process of prescribing error feedback, grounded in non-technical skills educational theory, reduces prescribing errors within a hospital setting. This system is cost effective as well as requiring minimal resource to instigate

Do Gasoline Prices Affect Residential Property Values?

This paper estimates the effect of gasoline prices on home values and explores the degree to which the relationship varies across a city. Using data from 930,702 home sales in Clark County, Nevada, from 1976 through 2010, we find that gasoline prices have significantly different effects on the sales price of homes in different neighborhoods. A ten percent increase in gasoline prices is associated with changes in location-specific average home values that span a range of over $13,000. This suggests that energy policies may affect household housing wealth via gasoline prices, a heretofore unrecognized distributional outcome